Residual pulmonary hypertension after left to right shunt closure in common pediatric congenital heart diseases: rate and risk factors

Abstract

Introduction: Left to right shunt in congenital heart disease is the common causes of pulmonary hypertension (PH) in children, and the pulmonary pressure sometime isn’t recovered to normal value after the shunts closed. Residual PH after correcting these shunts may cause deaths. The purpose of this study was to describe the rate of residual PH after surgical closure the left to right shunts in pediatric congenital heart disease and determine its risk factors.
 Patients and methods: A retrospective study was performed on the medical recorded documents of 59 children who were diagnosed pulmonary artery hypertension associated with common left to right shunt congenital heart diseases and performed shunt closure surgically at Cho Ray hospital between January 2020 and May 2022. Systolic pulmonary artery pressure (PAPs) was measured via tricuspid regurgitation jet on transthoracic echocardiography (mode: continuous wave doppler, plane: apical 4-chamber). PH was defined as PAPs ≥ 40mmHg. Postoperative PAPs was measured 1 day before discharge.
 Results: The median age and weight at surgery were 7 months (2 – 215) and 5.9 kg (3.6 – 35), 59.3% was female. Preoperatively, 66.1% were mild PH, 33.9% moderate. Postoperatively, 10 patients (17%) diagnosed residual PH and all was mild. Among 10 patients with residual PH: 7 were combined defects (5 VSD-PDA, 2 VSD-ASD), 3 simple defects (2 VSD, 1 ASD). Preoperative high pulmonary pressure was associated with residual PH (correlation coefficient 0.116, p = 0.001). Conclusions: The proportion of patients with postoperatiovely residual PH is significant and most of these cases are combined shunt. Preoperative high pulmonary pressure is related to residual PH.